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Health Law
University of Iowa School of Law
Kurtz, Sheldon F.

 
Health Law Outline
Professor Kurtz
Fall 2014
 
 
 
Chapter Two: The Treatment Relationship – Formation and Termination
       I.            The Duty to Treat
a.      The Duty to Accept Patients
                                                               i.            RULE: Physicians have no common law duty to treat, even in emergencies. Hurley v. Eddingfield
1.      Formation of doctor-patient relationship is one arising by contract.
2.      Spell of illness doctrine à once a patient recovers from an illness or stops seeking treatment, a new treatment relationship must be formed in order to invoke a duty of continuing treatment.
3.      Fee-for-service plan à Doctors who are members of this plan agree to treat or provide service to any patient who is a member of that plan. Involves contract between insurance entity and doctors. Patient is third-party beneficiary.
                                                             ii.            RULE: Hospitals have common law duty to treat emergency patients regardless of payment, but only in severe emergencies. Wilmington General Hospital v. Manlove
1.      Must at least stabilize the patient, finds liability where patient has relied upon a well-established custom of the hospital to render aid in such a case.
                                                           iii.            RULE: Because Constitution does not require municipalities to provide any emergency medical services at all, it would be anomalous indeed to hold them liable for providing limited services which happen to be less extensive than a particular citizen may desire. Wideman v. Shallowford Community Hospital:
                                                           iv.            Rule: Physician’s complete freedom to refuse treatment exists only if a treatment relationship has not been initiated.
b.     EMTALA
                                                               i.            RULE: Doctor is liable under EMTALA, where:
1.      Emergency medical condition or active labor existed.
2.      Doctor failed to treat or stabilize patient before transfer and material deterioration of the condition could have resulted from transfer. Burdett v. U.S. Department of Health and Human Services:
                                                             ii.            Under EMTALA, if you want to receive Medicare dollars, you must 1) have an emergency room, 2) screen all patients who present themselves in the room to ascertain if they have an emergency and 3) if they have an emergency, stabilize the patient who has an emergency.
1.      Even without emergency, they still really must treat because they have begun treatment through the screening, and thus a doctor-patient relationship, which subjects them to standard malpractice law.
2.      What motivated EMTALA was patient dumping.
                                                           iii.            Emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in
1.      Placing the patient’s health in serious jeopardy
2.      Serious impairment to bodily functions, or
3.      Serious dysfunction of any bodily organ or part.
                                                           iv.            EMTALA does not require the impossible for stabilizing emergency patients. If a hospital doesn’t have the facilities or personnel and the patient must go to a more sophisticated hospital to receive needed care, they can be transferred without violation of EMTALA.
1.      Have to do all you can to stabilize, but don’t have to do what you can’t.
                                                             v.            EMTALA protects both people who can’t afford care and even people for whom care is futile.
c.      Wrongful Reasons to Reject Patients – Discrimination
                                                               i.            Holding: Baby Doe, born with serious birth defects, was treated in evenhanded manner in that hospital has been and remains willing to perform the surgeries if parents would consent.  No violation of Section 504 of Rehabilitation Act. Requiring the hospital either to undertake surgery notwithstanding the parents’ decision or alternatively, to petition the state court to override the parents’ decision, would impose a particularly onerous affirmative action burden upon the hospital. United States v. University Hospital
                                                             ii.            Holding: Doctors can take into account the risks imposed – on the patient and on themselves – by the prospect of surgery on an HIV patient. Of course, if they do properly conclude that there are risks, they must also consider whether it is possible to make reasonable accommodations to enable the patient to undergo surgery despite those risks, in accordance with Rehabilitation Act. Glanz v. Vernick
1.      Rejects notion that in all cases we will defer to doctor’s judgment as to wh

advice or where they refuse service on religious grounds. Tunkl v. Regents of the University of California
c.      Terminating the Treatment Relationship
                                                               i.            RULE: Physician or surgeon, upon undertaking an operation or other case, is under the duty, in the absence of an agreement limiting the service, of continuing his operation or first treatment, so long as the case requires attention.
1.      Obligation of continuing attention can be terminated only by the cessation of the necessity that gave rise to the relationship, by the discharge of the physician by the patient, or by the withdrawal from the case by the physician after giving the patient reasonable notice so as to enable the patient to secure other medical attention.
a.       Spell of illness
b.      Patient fires doctor
c.       Doctor withdraws and gives reasonable notice – procedural standard.
2.      Physician has right to withdraw, but first, must give the patient sufficient notice so that they may seek other medical attention, if the case is such to still require further medical or surgical attention. Ricks v. Budge
                                                             ii.            RULE: As long as you provide reasonable notice and reasonable opportunity to find someone else, physician-patient relationship can be terminated.
1.      Procedural rule doesn’t require that doctor provide referral or list of other doctors. Payton v. Weaver
 
Chapter Three: The Treatment Relationship – Confidentiality, Consent, and Conflicts of Interest
I.       The Fiduciary Nature of the Treatment Relationship
i.         Privileged communication cannot be forcefully disclosed against the communicator’s will in judicial proceedings, administrative proceedings, legislative proceedings, etc.
1.      Doctor-patient
ii.       Confidential communication is communication that the parties have agreed will be confidential, but it may not necessarily be protected by the evidentiary privilege.